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The use of mesh in abdominal rectus diastasis

Diastasis of the rectus abdominis: why use mesh

I decided to write this short article to answer a question I get from practically all patients who come to me with a problem of diastasis of the rectus abdominis: "Doctor, do you really have to use it, the net?"

Yes, one has to use it. Apart from the fact that the technical R.E.P.A. which I propose - i.e. the minimally invasive endoscopic repair developed by Dr. Juarez Muas - specifically provides for it, all surgeons involved in abdominal wall surgery have known for decades that the use of mesh has drastically reduced the incidence of postoperative recurrence of hernias and other wall defectsWhereas before their introduction, recidivism could be expected in more than 20% of cases, today it is less than 4%. However, it is true that nets act as a foreign bodyand that their introduction into a living organism is not without consequences. The body reacts to the presence of a net, as it does to any other object that is introduced into it. On the one hand, however, this reaction is precisely part of the mechanism by which the nets make the repair of the defect more stable and secure; in fact, the formation of fibrous tissue that penetrates between the meshes of the net is precisely what makes the repair more solid and durable; to put it simply, it is as if a hard, resistant scar were formed where there was previously a hole. This applies to every wall defect, including the diastasis of the rectus abdominis. During the operation, the rectus muscles are realigned on the midline of the body and sutured together (we surgeons call this operating time 'reconstruction of the midline'): the mesh stabilises and reinforces this suture, both through its own characteristic mechanical capacities and, above all, by inducing the formation of the 'hard and resistant scar' we have just talked about.

Diastasis of the rectus abdominis: which net to use?

Networks, however, are not all the same.

diastasis of the rectus abdominis

A necessary premise is that in this intervention we use the polypropylenean inert, infection-resistant plastic discovered by an Italian scientist, Giulio Nattawho won the Nobel Prize in Chemistry in 1963 for this. The vast majority of meshes used in wall surgery today are made of, or are based on, polypropylene.

However, there is not just one type of polypropylene net. These nets differ from each other in weight and for the weaving (i.e. the way the polypropylene filaments are woven together, three-dimensionally).

Based on weight, there are networks ultralight (less than 35 g/m2), read (between 35 and 70 g/m2), standard (between 70 and 140 g/m2) e heavy (over 140 g/m2). A brilliant article on this classification, written by the late Andrea Coda (one of the most important Italian wall surgeons, who died prematurely a few years ago), can be read here. This distinction is not purely academic: in fact the weight of the mesh is one of the determining factors in the origin of postoperative pain, the foreign body sensation and the stiffness of the area in which the prosthesis is placed. A review very important on this type of problem, referring specifically to inguinal hernia repair but also applicable to all other cases of prosthetic abdominal wall surgery, was published in 2012 on British Journal of Surgeryone of the most important surgical journals in the world. In this article, it is clearly pointed out that light and utralight nets cause much less stiffness, less pain and very little foreign body sensation than standard and heavy nets.

The 'comfort' of a net is therefore the greater the lesser its weight. This topic becomes all the more important when one considers that the majority of patients who undergo surgery for a diastasis of the rectus abdominis are young, physically fit and sporty - and will therefore have to live with the net for a long time, and this will hopefully have to be compliant with their lifestyle. Therefore, ultralight nets are the most suitable in these cases.

Ultralight nets weighing 20 g/m are now available2which makes it possible, once the prosthesis has been cut out, to leave less than 0.5 g of 'foreign body' implanted in patients.

Diastasis of the rectus abdominis and prosthesis: concluding...

The conclusion of all this is obvious: in view of the previously mentioned characteristics of patients undergoing surgery for diastasis of the rectus abdominisand the dynamic lifestyle they generally lead, the best nets for this surgery are ultralight netsmaximum comfort, minimum stiffness, minimum or no foreign body sensation.

13 thoughts on “L’uso della rete nella diastasi dei retti addominali”

    1. Good evening. The most concrete risk is recurrence of diastasis with rupture of the mesh. That is why one of the requirements for candidacy for surgery is to be sure that you do not want any more children.
      Sincerely yours.

  1. Dear Doctor, does the foreign body sensation persist for life or does it disappear a few months/years after surgery? Thank you very much.

    1. Good morning. The foreign body sensation varies from patient to patient and depends a lot on the net you use. Using light or ultralight nets, it is not felt. With heavier nets, it may persist over time.

  2. I wanted to ask if it will then be possible to lead a normal life after the operation and do some sport.

  3. Good morning doctor, I was operated on for deverticulitis, in 2012, after waiting about 20 months for the recanalisation operation, I was told that I would be put on the list to have a retina put in, until last year nothing, (only 10 years had passed) in April 2022, I was rushed to hospital and I was put in implants, as I had been living with annoying and painful hernias for several years, in your opinion the retina should have been placed right away? Thank you for your answer

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